A case study of global health at the university: implications for research and action

What is the role of global health and sustainable development in Swedish medical education? A qualitative study of key stakeholders' perspectives

BACKGROUND

Global health and sustainable development have increasingly been recognised as important parts of medical education, yet education on these issues remains fragmented and scarce. In 2020, a bill to reform the national medical curricula across all Swedish medical schools was introduced, including a greater emphasis on global health and sustainable development. This study aimed to explore the perspectives of key stakeholders in medical education on the role of global health and sustainable development in Swedish medical education.

METHODS

This was a qualitative study based on semi-structured interviews with 11 key stakeholders in medical education, broadly defined as faculty board members (dean and/or vice-deans for medical education) and/or programme chairs representing six universities. Data were analysed using qualitative content analyis (QCA). The study was conducted according to the Consolidated Criteria for Reporting Qualitative research (COREQ) guidelines.

RESULTS

Stakeholders discussed the challenges and opportunities associated with the modification of medical education, which was seen as necessary modernisation to fit the changing societal perception of the role of medical doctors. The anchoring process of redesigning the curriculum and integrating global health and sustainable development was discussed, with emphasis on ownership and mandate and the role of teachers and students in the process. Finding a shared understanding of global health and sustainable development was perceived as a challenge, associated with resistance due to fear of curriculum overload. To overcome this, integrating global health and sustainable development with other topics and developing existing components of the curricula were seen as important. Additionally, it was stressed that fostering capacity building and developing infrastructure, including utilization of digital tools and collaborations, were essential to ensure successful implementation.

CONCLUSIONS

Medical institutions should prepare future doctors to respond to the needs of a globalised world, which include knowledge of global health and sustainable development. However, conceptual uncertainties and questions about ownership remain among key stakeholders in medical education. Yet, key stakeholders also highlight that the inclusion of global health and sustainable development in the new curricula represents multiple overarching educational opportunities that can bring about necessary improvement.

Implementation of a re-designed pre-departure training program for global health advanced pharmacy practice experiences

BACKGROUND AND PURPOSE

This article describes the re-design and preliminary impact of a pre-departure global health training program for nine advanced pharmacy practice experience (APPE) sites.

EDUCATIONAL ACTIVITY AND SETTING

The program was re-designed from a half-day orientation to a six-week (six-hour total) program. Students explored global health, cultural competency, adaptability, safety, and travel logistics. The program's impact on student learning was indirectly assessed using closed- and open-ended items on pre- and post-program surveys. Students reported self-perceived agreement with eight statements regarding travel logistics and 17 statements regarding global health.

FINDINGS

Fifty-five students took the pre-course survey, and 47 students took the post-program survey for response rates of 100% and 85%, respectively. Students indicated significant change on 23 out of 25 statements, demonstrating meaningful improvements in agreement in both global health, logistics, and safety. Students were most interested in learning about travel logistics and healthcare information about their specific country upon entry into the program. At the conclusion of the program, students most often reported learning about cultural competency and adaptability. Most students reported no remaining questions. Course design, delivery, and assessment experience was provided for two academic postdoctoral fellows through the implementation of the re-designed program.

SUMMARY

Students perceived improved understanding and comfort with global health concepts and travel logistics after the pre-departure program, despite the diverse nature of rotation sites covered. More research is needed to understand what impact a pre-departure training program has on the overall global health student experience.

Creating a Global Community of Practice for Oncofertility

Fertility preservation in the cancer setting, known as oncofertility, is a field that requires cross-disciplinary interaction between physicians, basic scientists, clinical researchers, ethicists, lawyers, educators, and religious leaders. Funded by the National Institutes of Health, the Oncofertility Consortium (OC) was formed to be a scientifically grounded, transparent, and altruistic resource, both intellectual and monetary, for building this new field of practice capable of addressing the unique needs of young patients with cancer. The OC has expanded its attention to include other nonmalignant conditions that can threaten fertility, and the work of the OC now extends around the globe, involving partners who together have created a community of shared effort, resources, and practices. The OC creates materials that are translated, disseminated, and amended by all participants in the field, and local programs of excellence have developed worldwide to accelerate the pace and improve the quality of oncofertility research and practice. Here we review the global oncofertility programs and the capacity building activities that strengthen these research and clinical programs, ultimately improving patient care.

Creating global health leaders in pharmacy by evolving postgraduate training

There has been a push for increasing global health education and training opportunities within the pharmacy profession. Global health postgraduate learning opportunities are necessary to define pharmacy career paths in global health and develop global health leaders. There are many challenges to starting a global health postgraduate training program including economic burden, logistics of extramural rotations, local and international resources, and program sustainability. In the face of barriers inhibiting formal program establishment, different strategies can be used to incorporate global health topics into existing postgraduate training opportunities. Possible solutions include relating local health to global health to develop a global mindset, expanding upon existing partnerships to provide international global health experiences, use of technology and simulation for virtual global health interaction, and emphasis of implementation science principles to connect and translate local health interventions to a global scale.

Creating a Global Community of Practice for Oncofertility

Fertility preservation in the cancer setting, known as oncofertility, is a field that requires cross-disciplinary interaction between physicians, basic scientists, clinical researchers, ethicists, lawyers, educators, and religious leaders. Funded by the National Institutes of Health, the Oncofertility Consortium (OC) was formed to be a scientifically grounded, transparent, and altruistic resource, both intellectual and monetary, for building this new field of practice capable of addressing the unique needs of young patients with cancer. The OC has expanded its attention to include other nonmalignant conditions that can threaten fertility, and the work of the OC now extends around the globe, involving partners who together have created a community of shared effort, resources, and practices. The OC creates materials that are translated, disseminated, and amended by all participants in the field, and local programs of excellence have developed worldwide to accelerate the pace and improve the quality of oncofertility research and practice. Here we review the global oncofertility programs and the capacity building activities that strengthen these research and clinical programs, ultimately improving patient care.

The international medical elective in Nepal: perspectives from local patients, host physicians and visiting students

OBJECTIVES

To understand the impact of the international medical elective (IME) on Nepali patients and physicians alongside visiting European and American medical students.

METHODS

At a hospital in Nepal, semi-structured interviews were conducted with 15 patients and 15 physicians about positive and negative experiences with visiting medical students. Likert scale surveys about knowledge of Nepal, clinical competencies, and post-elective feedback were administered to 56 visiting medical students before and after their elective. Interviews were coded using conventional content analysis and surveys were analyzed using descriptive statistics and paired t-tests.

RESULTS

Emergent positive themes from interviews were that visiting students enhanced the reputation of the hospital, afforded financial benefits, improved international collaboration, and increased knowledge, culture and language exchange. However, negative themes were the language barrier and time expended to orient students. Before vs. after the elective, visiting students had increased knowledge of Nepal's healthcare system (M=1.9, SD=0.6 vs. M=3.2, SD=0.6, t₍₅₅₎=-10.22, p<.001), ability to communicate with health professionals from different backgrounds (M=3.3, SD=0.7 vs. M=3.6, SD=0.7, t₍₅₅₎=-3.11, p=0.003) and practice in resource constrained environments (M=2.4, SD=0.9 vs. M=2.8, SD=0.9, t₍₅₅₎=-2.42, p=0.02). However, students had no change in history (M=4.0, SD=0.7 vs. M=3.9, SD=0.7, t₍₅₅₎=0.84, p=0.40), physical exam (M=3.9, SD=0.6 vs. M=3.9, SD= 0.7, t₍₅₅₎=0.22, p=0.82) or diagnostic (M=3.5, SD=0.7 vs. M=3.4, SD=0.8, t₍₅₅₎=1.52, p=0.14) abilities.

CONCLUSIONS

This study demonstrated a variety of benefits and harms of the IME. To improve the IME experience, medical educators should emphasize pre-departure orientation and fostering equitable partnerships between sending and receiving institutions.

The international partner universities of East African health professional programmes: why do they do it and what do they value?

BACKGROUND

Globalization and funding imperatives drive many universities to internationalize through global health programmes. University-based global health researchers, advocates and programmes often stress the importance of addressing health inequity through partnerships. However, empirical exploration of perspectives on why universities engage in these partnerships and the benefits of them is limited.

OBJECTIVE

To analyse who in international partner universities initiated the partnerships with four East African universities, why the partnerships were initiated, and what the international partners value about the partnerships.

METHODS

Fifty-nine key informants from 26 international universities partnering with four East African universities in medicine, nursing and/or public health participated in individual in-depth interviews. Transcripts were analysed thematically. We then applied Burton Clark's framework of "entrepreneurial" universities characterized by an "academic heartland", "expanded development periphery", "managerial core" and "expanded funding base", developed to examine how European universities respond to the forces of globalization, to interpret the data through a global health lens.

RESULTS

Partnerships that were of interest to universities' "academic heartland" - research and education - were of greatest interest to many international partners, especially research intensive universities. Some universities established and placed coordination of their global health activities within units consistent with an expanded development periphery. These units were sometimes useful for helping to establish and support global health partnerships. Success in developing and sustaining the global health partnerships required some degree of support from a strengthened steering or managerial core. Diversified funding in the form of third-stream funding, was found to be essential to sustain partnerships. Social responsibility was also identified as a key ethos required to unite the multiple elements in some universities and sustain global health partnerships.

CONCLUSION

Universities are complex entities. Various elements determine why a specific university entered a specific international partnership and what benefits it accrues. Ultimately, integration of the various elements is required to grow and sustain partnerships potentially through embracing social responsibility as a common value.

Global health education in Germany: an analysis of current capacity, needs and barriers

BACKGROUND

In times of increasing global challenges to health, it is crucial to create a workforce capable of tackling these complex issues. Even though a lack of GHE in Germany is perceived by multiple stakeholders, no systematic analysis of the current landscape exists. The aim of this study is to provide an analysis of the global health education (GHE) capacity in Germany as well as to identify gaps, barriers and future strategies.

METHODS

An online search in combination with information provided by student representatives, course coordinators and lecturers was used to create an overview of the current GHE landscape in Germany. Additionally, a semi-structured questionnaire was sent to GHE educators and students engaged in global health (GH) to assess the capacity of German GHE, its barriers and suggested strategies for the future.

RESULTS

A total of 33 GHE activities were identified at 18 German universities. Even though medical schools are the main provider of GHE (42%), out of 38 medical schools, only 13 (34%) offer any kind of GHE. Modules offered for students of other health-related professions constitute 27% of all activities. Most survey respondents (92%, n = 48) consider current GHE activities in Germany insufficient. Suggested formats were GHE as part of medical curricula (82%, n = 45) and dual degree MD/MPH or PhD programs. Most important barriers mentioned were low priority of GH at faculties and academic management levels (n = 41, 75%) as well as lack of necessary institutional structures (n = 33, 60%).

CONCLUSIONS

Despite some innovative academic approaches, there is clearly a need for more systematic GHE in Germany. GHE educators and students can take an important role advocating for more awareness at university management level and suggesting ways to institutionalize GHE to overcome barriers. This study provides key evidence, relevant perceptions and suggestions to strengthen GHE in Germany.